Search

The analysis of large amounts of data from electronic medical records (EMRs) and daily clinical practice data sources has received increasing attention in the last years. However, few systematic approaches have been proposed to support the extraction of the wealth and diversity of information from these data sources. Specifically, Acute Coronary Syndrome (ACS) data are available in many hospitals and health units because ACS shows elevated morbidity and mortality. This work proposes a method called Data Science Analysis and Representation (DSAR) to scrutinize and exploit, in a univariate way, scientific information content in limited ACS samples. DSAR uses Bootstrap Resampling to provide robust, cross-sectional, and non-parametric statistical tests on categorical and metric variables. It also constructs an informative graphical representation of the database variables, which helps to interpret the results and to identify the relevant variables. Our objectives were to validate DSAR by comparing it to conventional statistical methods when looking for the most relevant variables in the secondary prevention of ACS, and to determine the degree of correlation between them and the Exitus event (associated with patient death). To achieve this objective, we applied DSAR on an anonymized sample of 270 variables from 2377 patients diagnosed with ACS. The results showed that DSAR identified 44% significant variables while conventional methods offered weak correlation results. Then, the scientific literature was reviewed for a set of these variables, validating the agreement with clinical experience and previous ACS research. The conclusion is that DSAR is a valuable and a useful method for clinicians in the identification of potentially predictive variables and, overall, a good starting point for future multivariate secondary analyzes in the clinical field of ACS, or fields with similar information characteristics.

Introduction and objectives To study the incidence, predictors and prognosis of follow-up de novo heart failure (HF) after discharge for acute myocardial infarction (AMI) in patients with left ventricular ejection fraction (LVEF) ≥ 50% and without previous history of HF. Methods Retrospective multicenter registry that includes 2158 consecutive patients discharged for AMI, from January 2011 to December 2015, with LVEF ≥ 50% and without history of HF. The association between clinical variables and the development of de novo HF was assessed by Fine–Gray proportional hazards regression analysis, accounting for death as a competing episode. The adjusted effect of post-discharge HF on subsequent mortality was investigated using extended Cox proportional hazards model. Results During follow-up (20.1 ± 11.8 months), 60 patients (2.8%) had HF admissions, with a cumulative incidence function of 1.7 per 100 patient-year. Age ≥ 70 years, hypertension, atrial fibrillation, and renal dysfunction were independent risk factors for follow-up HF. The HF incidence rate after surviving AMI increased with a higher number of risk factors, from 0.1% in patients with 0, to 1.8%, 3.8%, 15.3%, and 19% in patients with 1, 2, 3, and 4 risk factors, respectively (P Conclusions De novo HF after hospital discharge for ACS in patients with LVEF ≥ 50% is an independent predictor of follow-up death. Fortunately, it is an infrequent post-AMI complication and is easily predictable the combination of 4 clinical risk factors.

Introduction and objectives The concurrence of cancer and ischemic heart disease is a controversial issue, given the confluence of risk factors for both diseases. The aim of this study is to analyze the incidence, predictors, and prognosis of new-onset cancer after an acute coronary syndrome (ACS). Methods Retrospective multicenter registry that includes 3867 consecutive patients discharged for ACS without a known history of cancer, from 2011 to 2015. The association between clinical variables and cancer occurrence was assessed by Fine-Gray proportional hazards regression analysis, and its prognostic impact was evaluated using Cox and Fine-Gray regression models. Results The cumulative incidence of cancer was 2.47 per 100 patient/years. Four independent predictors of follow-up cancer were identified: age, male sex, smoking, and human immunodeficiency virus infection. We have constructed a simple risk score, based on the coefficients of these variables in the final multivariable model. Using this score, we stratified our population according to the risk of developing cancer: low (1.03% per year), moderate (2.35% per year), and high-risk (10.51% per year) groups. Post-discharge cancer was independently associated with an increased risk of non-cardiovascular death (HR, 17.65; 95%CI, 10.47–29.76) and bleeding (sHR, 2.54; 95%CI, 1.21–5.34), but not with reinfarction (sHR, 0.50; 95%CI, 0.16–1.56). Conclusions Cancer occurrence after hospital discharge for ACS is relatively low, but it could be predicted by the combination of 4 easily available clinical risk factors: age, male sex, smoking, and human immunodeficiency virus infection. Post-discharge cancer is associated with a higher risk of subsequent death and bleeding events. Resumen Introduccion y objetivos La simultaneidad de cancer y cardiopatia isquemica es un tema controvertido, dada la confluencia de factores de riesgo entre ambas enfermedades. Con este estudio se pretende analizar la incidencia, los factores predictores y el pronostico del cancer de novo tras el alta hospitalaria por sindrome coronario agudo (SCA). Metodos Se trata de un registro multicentrico retrospectivo que incluyo 3.867 pacientes dados de alta tras el SCA y sin historia previa de cancer, de forma consecutiva desde 2011 hasta 2015. La asociacion entre las variables basales y cancer se estudio mediante un analisis de regresion de Fine-Gray, y su impacto pronostico se evaluo mediante modelos de regresion de Cox y de competencia de riesgo (Fine-Gray). Resultados La incidencia acumulada de cancer fue de 2,47 por 100 pacientes/ano. Se identificaron 4 factores de riesgo: edad, sexo masculino, tabaquismo e infeccion por el virus de la inmunodeficiencia humana. De esta forma se construyo una escala de riesgo simplificada basada en los coeficientes de estas variables en el modelo multivariado final. Con esta puntuacion se estratifico nuestra poblacion en funcion del riesgo de desarrollar cancer: riesgo bajo (1,03% por ano), moderado (2,35% por ano) y alto (10,51% por ano). El desarrollo de cancer tras el alta se asocio de forma independiente con un riesgo aumentado de muerte de causa no cardiovascular (HR=17,65; IC95%, 10,47-29,76) y hemorragia (sHR=2,54; IC95%, 1,21-5,34), pero no con reinfarto (sHR=0,50; IC95%, 0,16-1,56). Conclusiones La aparicion de cancer tras el ingreso hospitalario por SCA es relativamente baja, pero se puede predecir a partir de la combinacion de 4 factores de riesgo facilmente disponibles en la practica clinica: edad, sexo masculino, tabaquismo e infeccion por el virus de la inmunodeficiencia humana. El cancer de novo se asocio con mayor riesgo consecuente de muerte no cardiovascular y hemorragia.

The goal of this study was to determine the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and follow-up heart failure (HF) according to left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI). This cohort study used a retrospective registry of 8169 consecutive patients discharged with a diagnosis of AMI from two university hospitals in Spain between 2010 and 2016. We used a multivariable competing risk analysis, survival-time inverse probability weighting (IPW) propensity score adjusting, and propensity score matching (PSM) to investigate the association between ACEI/ARB treatment and follow-up HF. During the follow-up (3.3 ± 2.2 years), 1296 patients were admitted for HF (5.2 per 100 person-years). ACEI/ARB use was not associated with fewer follow-up HF admissions in patients with LVEF > 40% (univariate analysis: sub-hazard ratio [sHR] 1.10; 95% confidence interval [CI] 0.95–1.27; p = 0.197; IPW adjusting analysis: sHR 1.11; 95% CI 0.95–1.29; p = 0.192; PSM analysis: sHR 1.12; 95% CI 0.92–1.36; p = 0.248). However, ACEI/ARB use was associated with a significant reduction in HF admission rates in patients with LVEF ≤ 40% (univariate analysis: HR 0.70; 95% CI 0.56–0.88; p = 0.003; IPW adjusting analysis: HR 0.64; 95% CI 0.50–0.83; p = 0.001; PSM analysis: HR 0.65; 95% CI 0.46–0.92; p = 0.014). Among hospitalized survivors of AMI, the use of ACEIs/ARBs was associated with a lower risk of follow-up HF in patients with LVEF ≤ 40% but not in those with LVEF > 40%. Further prospective studies are needed to confirm our results.

Background The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS population. Methods Data from the multicenter REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) for 4424 ACS patients who underwent PCI and were treated with ticagrelor or prasugrel between 2012 to 2016 were analyzed. Mean follow-up was 17±9 months. Results After propensity score matching, there was no significant difference in the occurrence of primary endpoint of net adverse cardiac events between ticagrelor and prasugrel in men (HR: 0.94; 95% CI: 0.69-1.29; P=0.71), or women (HR: 1.17; 95% CI: 0.63-2.20; P=0.62; P interaction [sex] = 0.40). Similarly, no differences were found in the occurrence of any of the secondary endpoints (MACE, all cause death, re-infarction, stent thrombosis, BARC major bleeding and BARC any bleeding) between the two P2Y12 groups between men and women. Conclusions In this real-world ACS population, no relative difference in efficacy or safety outcomes were found between ticagrelor and prasugrel between sexes.

Introduction and objectives Acute coronary syndrome (ACS) guidelines recommend the use of newer P2Y12 inhibitors (prasugrel and ticagrelor) over clopidogrel in patients with moderate-to-high ischemic risk, unless they have an increased bleeding risk. The aim of our study was to assess the GRACE risk score and the CRUSADE bleeding risk score relative to prescription of newer P2Y12 inhibitors at discharge in ACS patients. Methods Retrospective analysis of a multicenter ACS registry; 3515 consecutive patients were included. The association between risk scores and prescription of newer P2Y12 inhibitors was assessed by binary logistic regression analysis. Results A total of 1021 patients (29%) were treated with prasugrel or ticagrelor. On multivariate analyses, both GRACE (OR per 10 points, 0.89; 95%CI, 0.86-0.92; P Conclusions New P2Y12 inhibitors were more frequently prescribed among ACS patients with lower CRUSADE bleeding risk. However, an ischemic risk paradox was found, with higher use of these agents in patients with lower ischemic risk based on GRACE risk score estimates. These results underscore the importance of risk stratification to safely deliver optimal therapies.

Resumen Introduccion y objetivos Las guias sobre sindrome coronario agudo (SCA) recomiendan el uso de los nuevos inhibidores del P2Y12 (prasugrel y ticagrelor) antes que el clopidogrel para los pacientes con riesgo isquemico moderado-alto, siempre que no tengan un riesgo hemorragico elevado. El objetivo de nuestro estudio es evaluar la escala de riesgo isquemico GRACE y la de riesgo hemorragico CRUSADE en relacion con la prescripcion de los nuevos inhibidores del P2Y12 al alta en pacientes con SCA. Metodos Analisis retrospectivo de un registro multicentrico de SCA. Se incluyo a 3.515 pacientes consecutivos. La asociacion entre las escalas de riesgo y la prescripcion de los nuevos inhibidores del P2Y12 se evaluo mediante analisis de regresion logistica binaria. Resultados Se trato con prasugrel o ticagrelor a 1.021 pacientes (29%). En el analisis multivariable, tanto la escala GRACE (cada 10 puntos, OR = 0,89; IC95%, 0,86-0,92; p Conclusiones Los nuevos inhibidores del P2Y12 se prescribieron con mayor frecuencia a los pacientes con SCA con menor riesgo hemorragico CRUSADE. Sin embargo, se encontro una paradoja en cuanto al riesgo isquemico, con mayor uso de estos agentes para pacientes con menor riesgo estimado con la escala GRACE. Estos resultados subrayan la importancia de la estratificacion de riesgos para prescribir con seguridad las terapias optimas.

Background: Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease. Methods: We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate 2. Results: The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, p = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, p = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all p values >0.3). Conclusions: The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.

Background Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (GFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. Hypothesis New CKD-EPI equations improve risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and provide complementary information to the Global Registry of Acute Coronary Events (GRACE) risk score. Methods We studied 350 subjects (mean age, 68 ± 12 years; 70% male) with NSTE-ACS. Estimated GFR was calculated using the MDRD and new CKD-EPI equations based on serum creatinine (SCr) and/or cystatin C (CysC) concentrations obtained within 48 hours of hospital admission. The primary endpoint was all-cause death during follow-up. Results Over the study period (median, 648 days [interquartile range, 236–1042 days]), 31 patients died (0.05% events per person-year). Decedents had poorer renal-function parameters (P < 0.001). Both CysC-based CKD-EPI equations had the highest areas under the receiver operating characteristic curve for the prediction of all-cause mortality. After multivariate adjustment, only CysC-based CKD-EPI equations were independent predictors of all-cause mortality (CKD-EPISCr-CysC, per mL/min/1.73 m2: hazard ratio: 0.975, 95% confidence interval: 0.956-0.994, P = 0.009; CKD-EPICysC, per mL/min/1.73 m2: hazard ratio: 0.976, 95% confidence interval: 0.959-0.993, P = 0.005). Reclassification analyses showed that only CysC-based CKD-EPI equations improved predictive accuracy of the GRACE risk score. Conclusions In patients with NSTE-ACS, CysC-based CKD-EPI equations improved clinical risk stratification for mortality and added complementary prognostic information to the GRACE risk score.

Risk assessment plays a major role in the management of acute coronary syndrome. The aim was to compare the performance of the Global Registry of Acute Coronary Events (GRACE) and the Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the American College of Cardiology/American Heart Asociation guidelines (CRUSADE) risk scores to predict in-hospital mortality and major bleeding (MB) in 1,587 consecutive patients with acute coronary syndrome. In-hospital deaths and bleeding complications were prospectively collected. Bleeding complications were defined according to CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. During the hospitalization, 71 patients (4.5%) died, 37 patients (2.3%) had BARC MB and 34 patients (2.1%) had CRUSADE MB. Receiver operating characteristic curves analyses showed GRACE risk score has better discrimination capacity than CRUSADE risk score for both, mortality (0.86 vs 0.79; p = 0.018) and BARC MB (0.80 vs 0.73; p = 0.028), but similar for CRUSADE MB (0.79 vs 0.79; p = 0.921). Both scores had low discrimination for predicting MB in the elderly (>75 years) and patients with atrial fibrillation, whereas CRUSADE risk score was especially poor for predicting MB in patients with

Aim: To evaluate the clinical profile and effectiveness/safety of patients taking rivaroxaban in clinical practice. Methods: Retrospective study that included patients with nonvalvular atrial fibrillation treated with rivaroxaban for the prevention of stroke between January 2012 and December 2016 in a tertiary hospital in Spain. Results: A total of 142 patients (median age 78 years, 40.1% men, 32.4% creatinine clearance 2DS2-VASc ≥2; 44.3% HAS-BLED ≥3) were included. Only two patients had a thromboembolic event (in both cases ischemic stroke) and three patients had major bleeding (rates of 1.3 and 1.9 events/100 patient years, respectively). Conclusion: Data regarding effectiveness and safety in our cohort were consistent with previous studies, showing that rivaroxaban can be effective and safely used in our setting.

Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure.An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up.Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance60 mL/min or with advanced age (≥ 75 years) would have needed dosage adjustment during follow-up.The need for dosage adjustment of nonvitamin K oral anticoagulants during follow-up is frequent in patients with atrial fibrillation after acute decompensated heart failure, especially among older patients and those with renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation.

Background In patients with acute decompensated heart failure (ADHF), both natriuretic peptides and renal impairment predict adverse outcomes. Our aim was to evaluate the complementary prognosis role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the newly developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on cystatin C (CysC) for glomerular filtration rate (GFR) estimation in ADHF patients. Hypothesis Renal impairment assessed by CysC-based CKD-EPI equations and natriuretic peptides have complementary prognostic value in ADHF patients. Methods The study included 613 consecutive patients presenting with ADHF. At admission, plasma levels of NT-proBNP and CysC were determined. The GFR was estimated using CysC-based CKD-EPI equations. The primary endpoint was death from any cause and heart failure readmission. Results During the median follow-up of 365 days (interquartile range, 227–441 days), 323 patients (0.65 %patient-year) died or were readmitted for heart failure. After multivariate adjustment, estimated GFR 3251 pg/mL were independent predictors of adverse outcomes (P 3251 pg/mL was associated with the highest risk of adverse outcomes. Furthermore, reclassification analyses demonstrated that use of both NT-proBNP and CysC-based CKD-EPI equations resulted in improving the accuracy for adverse outcomes prediction. Conclusions In patients with ADHF, the combination of NT-proBNP with estimated GFR using CysC-based CKD-EPI equations better predicts outcomes than either parameter alone and adds valuable complementary prognosis information to other established risk factors.

Acute coronary syndrome (ACS) guidelines recommend the use of newer P2YRetrospective analysis of a multicenter ACS registry; 3515 consecutive patients were included. The association between risk scores and prescription of newer P2YA total of 1021 patients (29%) were treated with prasugrel or ticagrelor. On multivariate analyses, both GRACE (OR per 10 points, 0.89; 95%CI, 0.86-0.92; P.001) and CRUSADE (OR per 10 points, 0.96; 95%CI, 0.94-0.98; P.001) risk scores were inversely associated with the use of newer P2YNew P2Y

Introduccion y objetivos El ancho de distribucion eritrocitaria se ha relacionado con incremento del riesgo hemorragico intrahospitalario en pacientes con sindrome coronario agudo sin elevacion del ST. Sin embargo, se desconoce su utilidad para predecir complicaciones hemorragicas tras el ingreso hospitalario. El objetivo fue evaluar el papel complementario del ancho de distribucion eritrocitaria sobre la escala CRUSADE en la prediccion del riesgo a largo plazo de hemorragias en estos pacientes. Metodos Se midio el ancho de distribucion eritrocitaria al ingreso en 293 pacientes con sindrome coronario agudo sin elevacion del ST; a todos se les dio seguimiento clinico y se registro la aparicion de hemorragias mayores, definidas segun los criterios del Bleeding Academic Research Consortium. Resultados Durante un seguimiento de 782 [intervalo intercuartilico, 510-1.112] dias, 30 pacientes (10,2%) presentaron eventos hemorragicos. El analisis por cuartiles revelo un incremento abrupto de hemorragias a partir del cuarto cuartil (> 14,9%; p = 0,001). Tras el analisis multivariable, el ancho de distribucion eritrocitaria > 14,9% se asocio con mayor riesgo de eventos (hazard ratio = 2,67; intervalo de confianza del 95%, 1,17-6,10; p = 0,02). Los pacientes con valores = 14,9% y CRUSADE = 40 presentaron las menores tasas de hemorragias, mientras que los pacientes con valores > 14,9% y CRUSADE > 40 puntos (alto y muy alto riesgo) presentaron las mayores (log rank test, p < 0,001). Ademas, la adicion del ancho de distribucion eritrocitaria a la escala CRUSADE para predecir hemorragias mostro tasas de mejora integrada del 5,2% (p < 0,001) y de reclasificacion del 10% (p = 0,001). Conclusiones Los valores elevados del ancho de distribucion eritrocitaria se asocian a mayor riesgo hemorragico y aportan informacion adicional a la escala CRUSADE.

Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of this study was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with acute decompensated heart failure (ADHF).A total of 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated with the use of MDRD and CKD-EPI equations. The occurrences of mortality and heart failure (HF) hospitalization were recorded. Over the study period (median 365 days [interquartile range 238-370]), 305 patients (58%) died or were rehospitalized for HF. Areas under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with60 mL min(-1) 1.73 m(-2). After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (P.001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with significant improvement in reclassification analyses (net reclassification improvements 10.8% and 12.5%, respectively).In patients with ADHF, CysC-based CKD-EPI equations were superior to the MDRD equation for predicting mortality and/or HF hospitalization especially in patients with60 mL min(-1) 1.73 m(-2), and both CKD-EPI equations improved clinical risk stratification.

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p

Background Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate more accurately than the Modification of Diet in Renal Disease (MDRD) Study equation. Our aim was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for major bleeding (MB) more accurately than the MDRD Study equation in patients with non-ST-segment elevation acute coronary syndromes (ACS). Materials and methods Three hundred and fifty consecutive subjects with non-ST-segment elevation ACS (68 ± 12 years, 70% male) were studied. Glomerular filtration rate was estimated using the CKD-EPI and MDRD Study equations. The primary endpoint was the occurrence of MB during the follow-up, which was defined according to the Bleeding Academic Research Consortium Definition criteria as bleeding types 3–5. Results During the median follow-up of 589 days (interquartile range, 390–986), 27 patients had MB (0·04% events per person year). Patients with MB had worse kidney function parameters, regardless of the estimating equation used (P

Aims: To assess the feasibility and reliability of aortic valve area (AVA) planimetry by means of threedimensional transesophageal echocardiography (3DTEE) as compared with the transthoracic echocardiogram (TTE) calculation of AVA, to determine the systematic deviations between measurements, and to describe the distribution of mean systolic in relation with 3DTEE anatomical AVA. Methods and Results: Three hundred seven patients with aortic valve stenosis (AVS) underwent both TTE and 3DTEE for AVA measurement by means of the continuity equation and direct anatomical planimetry, respectively. AVA planimetry was achieved in 282 (91.9%) of patients. Severity of the aortic valve calcification was independently associated with a poorer performance of planimetry. Intraclass correlation coefficient yielded a 0.848 (95% CI: 0.807–0.879) value. 3DTEE rendered a mild constant underestimation of AVA in comparison with TTE. Severe aortic stenosis according to the area criterion (< 1c m 2 ) despite mean systolic gradient below 40 mm Hg was detected in 37.6% of the study population, and in 33.7% of the subset of patients with preserved left ventricular ejection fraction. Conclusions: Reliability of AVA planimetry by 3DTEE in comparison with the calculation by TTE is good, but 3DTEE underestimates slightly the measurement. Feasibility of the technique is good but independently affected by valvular calcification. Inconsistent classification of AVS severity as graded by AVA or mean systolic gradient is observed in the overall population and in patients with preserved systolic function. (Echocardiography 2014;00:1–8)

Introduction and objectives Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non–ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients. Methods Red cell distribution width was measured at admission in 293 patients with non–ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria). Results During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P = .001). After multivariate adjustment, red cell distribution width > 14.9% was associated with higher risk of events (hazard ratio = 2.67; 95% confidence interval, 1.17-6.10; P = .02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values > 14.9% and a CRUSADE score > 40 points (high and very high risk) had the highest rate of bleeding (log rank test, P